This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.

ABSTRACT

Background:

Asthma is a chronic common disease in pediatrics, it is more prevalent in children than in adults. It is a chronic inflammatory disease of the airway which leads to airflow obstruction. Wheezing, chest tightness, and repeated attacks of breathlessness are symptoms of asthma. It was reported that the prevalence of asthma is increasing.

Methodology:

The present study was conducted on the parents of children with asthma in the period from October 2017 to December 2017. The study was performed using an online survey, the data collected were entered in an excel sheet and then analyzed by SPSS program.

Results:

Asthma was prevalent in 77% of children, the mean number of asthma attacks in the previous year was 9.36 times. Wheezing presented in 73.2% children with asthma, symptoms of asthma and sleeping affected days was more common in a period of 1–3 days.

Conclusion:

There was a very high prevalence of asthma among children. Asthma was found to affect sleep of children in several aspects. The educational level of parents had no effect on the prevalence of asthma.

Keywords:

Asthma, asthma prevalence, children asthma.

Introduction

Asthma is one of the most common chronic diseases in pediatrics [1], it is more common in children than in adults [2], and it forms a major co-morbid illness [3]. It is a chronic inflammatory disease of the airway associated with broncho-constriction which leads to airflow obstruction [4]. It is characterized by wheezing and repeated attacks of breathlessness [5], whereas chest tightness and dyspnea are other symptoms of asthma [3].

There was an increase in the incidence of allergic diseases including bronchial asthma in the last three decades [6] and asthma prevalence among children has increased during the last two decades including Saudi Arabia [3,5]. Newacheck and Halfon [7] and Al-Dawood [8] reported that bronchial asthma in children was considered to be the most prevalent cause of childhood disability. The number of bronchial asthma patients in many countries has increased, the WHO estimated the number as 235 million people suffering asthma [9].

In Saudi Arabia, asthma is a common chronic disease, where more than 2 million individuals have been suffering from asthma [10]. Some specific reasons have been proposed as a cause of the increased asthma prevalence, including both environmental and genetic factors such as pollutants, life style, socioeconomic status, geographical area, tobacco smoke allergens, viral infections, low birth weight, and diet [2], the more prominent of the mentioned factors is the environmental factor [11].

Asthma is a very common cause of emergency visits to hospitals and absence from school for school-aged children; also, it causes morbidity which may even lead to death [2]. Allergic disorders including asthma cause high social and financial burden on the family and society [2]. The consequences include loss of work, absence from school, hospitalizations, and low quality of life [5].

Asthma is a non-curable chronic disorder, however, it has lower mortality rate than other similar chronic disorders [5]. History and interpretation of asthma symptoms are considered as important criteria in asthma diagnosis, it also depends on the reversibility and variability of pulmonary function tests, wheeze within 12 months is considered a marker for the diagnosis of asthma [3]. One of the pitfalls in the asthma management is under-diagnosis of asthma in children [3].

There were studies to determine asthma prevalence performed depending on a standardized international inventory called the International Study of Asthma and Allergies in Children [2]; based on these previous studies, there was systematic reviews that showed the mean prevalence of asthma in Iran between 1998 and 2003 was 13% [12].

Asthma prevalence in children aged from 6 to 10 years in some countries including Austria, Belgium, Finland, France, Italy, and Switzerland was reported to be less than 10%, while it was higher in other countries including Czech Republic (14.7%), Norway (13.6%), Bulgaria (14.5%), and Ireland (17.4%) [13]. The prevalence of asthma was 17% in Kuwait [14]. In Egypt, it was reported that asthma prevalence was 4.8% in Egyptian infants and children aged less than 4 years, from five governorates [15], while prevalence in children was 7.7% in the Nile Delta region of Egypt [3].

In Madinah, Saudi Arabia, it was reported that prevalence of asthma was 23.6% in those with age range of 6–8 years [16]. In another study in Saudi Arabia including different regions of the kingdom (Riyadh, Hail, Jeddah, and Gizan), it was reported that the prevalence of bronchial asthma among school children increased from 8% in 1986 to 23% in 1995 [17]. In a study in Al-Khobar, Saudi Arabia, asthma prevalence rate was 9.5% [8].

These differences in asthma prevalence between countries may be attributed to the difference in climate, air pollution, socioeconomic status, life style, exposure to respiratory infection, and variability of allergen levels [2]. The current study was established to evaluate the prevalence of asthma in children.

Subjects and Methods

The present study is a cross-sectional study, it was conducted on the parents of children with asthma in the period from October 2017 to December 2017. An online survey was used in this study to facilitate access to large number of participants, 243 individuals were included in this study.

Data were analyzed using SPSS software version 16, simple descriptive analysis in the form of numbers and percent for qualitative variables, mean and standard deviation for quantitative variables. Chi square was used as a test of significance to detect association between prevalence of asthma and education level, the student t-test was used to compare age between affected and unaffected children with a significant level of less than 0.05.

Results

In the present study, the mean age of participants was 32.02 ± 8.75 years old. The large majority of participants were female 202 (83.1%), while male participants were 41 (16.9%). The large majority were married 208 (85.6%) in this study, while there were 32 (13.2%) singles and 3 (1.2%) were divorced. Secondary education was the most common education level among 190 (78.2%) individuals, followed by intermediate education 33 (13.6%), then, university 14 (5.8%), and primary education 6 (2.5%). The mean number of children participants was 3.84 ± 2.32 children. One hundred and fifty-five (65.4%) participants reported that their children previously had problems in breathing such as coughing, while 82 (33.7%) said that they didn’t suffer such problems, and six (2.5%) only said that they didn’t know. One hundred and thirty-seven (56.4%) reported that their children were affected by cough or dry cough at night, while 98 (40.3%) answered no, and eight (3.3%) said that they didn’t know. There were 155 persons who reported that children had problem in breathing; so, they were asked to answer further questions mentioned in Table 1. There were 134 (86.5%) participants who reported that their children were disturbed during sleep as a result of breathing problems, while 73 (47.1%) mentioned that the breathing problems affected the activities of their children. Fifty (32.3%) said that the speaking of their children was interrupted by breathing, where they speak one or two words between breathing, the large majority 86 (55.5%) reported that they needed quick relief drugs for treating breathing problems and 40 (25.8%) reported using of oral cortisone, 56 (36.1%) said that their children were diagnosed of suffering from bronchial asthma.

The parents who had children who suffered bronchial asthma were asked further questions that are mentioned in Table 2. There were 41 (73.2%) parents who said that the chest of their children made a sound as a result of performing exercise, 23 (41.1%) said that their children experienced symptoms of asthma in 1–3 days, 14 (25%) said 4–10 days, and 19 (33.9%) said none. Asthma caused children to wake up during sleeping for 28 (50%) participants in 1–3 days, 7 (12.5%) in 4–10 days, whereas 21 (37.5%) weren’t affected by asthma during sleeping. The range of asthma attacks in the previous year for children was found to be 0–180 times with a mean ± SD of 9.34 ± 25.6 times.

The education level of parents and having children with asthma is shown in Figure 2. Parents with secondary education had the highest number of children with asthma 146 (78.1%), followed by those with intermediate education 28 (15%), then, those with university and primary education; 9 (4.8%) and 4 (2.1%), respectively.

The prevalence of asthma in children in the present study as reported by their parents was 77%, Figure 1 shows the prevalence rate of asthma among children.

Table 1. Answers of participants about six questions.

Questions

N (%)

Did your children were disturbed during sleep as a result of breathing problems?

Yes

134 (86.5%)

No

21 (13.5%)

Do the breathing problems of your children affect their daily and school activities?

Yes

73 (47.1%)

No

82 (52.9%)

Do your children speak only one or two words between breathing?

Yes

50 (32.3%)

No

105 (67.7%)

Do you need quick relief drugs to solve the breathing problems of your children?

Does the chest of your children make a sound during or after exercise?

No

15 (26.8%)

Yes

41 (73.2%)

During last 4 weeks, what was the number of days your children experienced asthma symptoms during daytime?

None

19 (33.9%)

1–3 days

23 (41.1%)

4–10 days

14 (25.0%)

During last 4 weeks, how many days your children awaked from sleeping due to asthma?

None

21 (37.5%)

1–3 days

28 (50.0%)

4–10 days

7 (12.5%)

Figure 2. Parents’ education of the asthmatic children.

Discussion

The prevalence of bronchial asthma among children in this study was high, the prevalence was found to be 77%. It was stated in Iranian study [2] that the prevalence rate of asthma among Iranian children ranged from 0.5% to 11% in 27 articles. Studies from Egypt reported prevalence of asthma is 9.4% in 11–15-year-old school going children in Cairo [18] and 8.2% was reported in another study of children with age of 3–15 years [19]. Previous studies from Saudi Arabia showed that the prevalence of physician-diagnosed asthma among children aged 6–12 years was 15.5% [16] and another study [20] demonstrated that the prevalence was higher 19.6% among adolescents aged 16–18 years. Higher prevalence of 27.5% was reported in a study from Najran, Saudi Arabia [6]; however, the prevalence in the present study was much higher. These findings confirm the previous reports and that prevalence of asthma is increasing in Saudi Arabia, where the prevalence among school children increased from 8% to 23% in the period from 1986 to 1995 [17]. The highest prevalence of asthma was among children whose parents had secondary education and the least rate of asthma prevalence was for children whose parents had primary education. Parents with secondary education had the highest number of healthy children among participants, while those with primary education had reported the least number of children with asthma. This showed that the education level of parents was not a factor for affecting prevalence of asthma among children and this suggests presence of other risk factors; however, in this study, risk factors were not investigated for asthma as the study was dependent on parents to assess the prevalence. Majority of children in this study were affected by breathing problems and their sleep was disturbed (86.5%), however, 47.1% were only affected during their daily activities and school activities and 32.3% were affected during speaking due to shortness in breath. This indicates that breathing problems affects sleep more than activities and speaking; so, it is important to take care of children during sleep to have good sleep, as disruption in sleep can negatively affect other activities and health of children. Egyptian study showed that shortness of breath was prevalent in 26% of asthma cases [3]. In the present study, there were 55.5% of children who needed quick relief drugs to solve the breathing problems and high percentage 74.2% needed oral cortisone as other drugs do not treat all breathing problems. 73.2% of children with bronchial asthma in this study suffered wheezing sound as a result of exercise. The most common duration in which children suffered asthma symptoms and waking due to asthma was 1–3 days after a month. The mean number of asthma attacks in the previous year was 9.36 times with a range of 0–180 times, this shows the high variation in the severity of asthma among children. In Egyptian study [3], it was reported that the most common frequency of attack was three times per year which represented 72.7% followed by 4–12 times/year (18.7%) and finally, more than 12 times/year (8.6%). The International Society for Augmentative and Alternative Communication (ISAAC) -phase III study reported that the mean global prevalence of wheezing among children aged 6–7 years was 11.7%, and 14.1% among children with 13–14 years [21]. In Saudi study [6], it was reported that the prevalence of wheezing has always been high. In one study [2], it was reported that wheezing was found in (3.8) 28.8% of children according to age, another study from Egypt [18] showed that wheezing prevalence in the last year was 14.7%, while another study [3] showed higher prevalence of 98.6% of recent wheezing for children aged 5–16 years.

The present study is the first study to assess the prevalence of asthma by asking parents about the presence of asthma among their children and complications their children faced using online survey. There were limitations in our study including that risk factors of asthma were not assessed among children and age of children was not investigated, this study was of different design, so, it couldn’t compare the findings with the previous ones.

Conclusion

There was very high prevalence of asthma among children in this study. Asthma was found to affect sleep of children in several aspects. The educational level of parents had no effect on the prevalence of asthma as the prevalence depended on other risk factors. Further studies are recommended to investigate the prevalence of asthma among children and to investigate its risk factors.

References

Kudzyte J, Griska E, Bojarskas J. Time trends in the prevalence of asthma and allergy among 6–7-year-old children results from ISAAC phase I and III studies in Kaunas, Lithuania. Medicina (Kaunas) 2008; 44(12):944–52.